Same formula, different country, different rules!

[PaulineCampbellJones]

I have needed to buy 9 month old DD some Aptamil while we are away in Spain as she has turned into a milk monster. The rules on the package are completely different to the ones on UK packets. Use mineral water so you don't have to boil the water!
Both are a complete no no and have seen many thread debates on this. Are we just living in a nanny state or is there a reason?
I will continue to boil water though as don't want to subject DD to too much change.

Is there a certain "concentration" of bacteria required before a healthy child becomes ill? If there's 1 bacteria is that OK, but if it's 100,000 not, IYSWIM.

Anyone know?

Nutramigen (UK) latest instructions on website indicate that it should be made up with water boiled and then cooled for 30 mins - same as WHO guidelines - it is Enfamil AR that says to leave boiled water to cool before mixing.

Plus there is a strong hint that both Nutramigen and Enfamil AR should both be freshly prepared. Enfamil AR is likely to clog up the teat if made with hot water because of the rice starch swelling - it is not recommended for pre-term babies nor those with compromised immune systems - however as a baby's immune system is not mature they are almost saying that the formula is not recommended for any baby!

Relaxedandcalm - are you in the UK - does your packet contradict what LindenAvery has found on the website?

ISNT - sterilisation is for the bottles as it is very easy for a small (teen tiny) amount of milk to be left on a bottle or in a teat unless the washing is scrupulous. Also bottles left out in a kitchen can be contaminated.

Why other countries dont recommend sterilising bottles I don't know.

The milk powder itself is not a sterile product hence the making up with 70 degrees C.

I believe that the number of bacteria is an important factor - i.e. the more there are the more likely a baby is to be affected.

That's why the time limit on using a feed is there.

See page 15 on these slides.

In those results the baseline scenario is making the feed with water which is 30 degrees and feeding immediately.

In all cases (even making in advance) using water at 70 degrees led to a reduction in risk of more than 100,000 times - this was regardless of the time between preparation and feeding.

So these experiements shows that it is much safer to make with 70 degree water IN ADVANCE than it is to make with cool water.

tabouleh
Yes am in the UK and yes the cartons (all recently picked up) apparently contradict the website information that the PP found although I've not found that info myself. I've just been on the nutramigen website and all I find is this:

"Always follow the instructions as per the can.

Feeding guide: see can unless your healthcare professional advises you otherwise."

Well, the can says "Boil fresh water....let it cool to room temperature before mixing."

I'm a massive supporter of breastfeeding - EBF for 7 months, only stopping because I was returning to work and it wouldn't have worked for me to express. I think groups like baby milk action do important work but I do think that there's some hysteria on here about the formula companies as if they are staffed by evil people who don't care about making babies sick and therefore don't provide accurate safety information. Sorry, but I just don't buy that. In reality, companies like Nestle (which yes, are run to make a profit - but even charities have the aim of making as much money as possible too....) are staffed by people like you and me, many of whom are parents, who have no interest in putting babies at risk. Yes, breastfeeding is best of course but formula has a place and the people who work in these companies just are not evil human beings.

Sorry - thread hijack I know but I get slightly infuriated when good conversations with useful info that helps people assess the risks in different ways of making up formula start going down the 'all formula companies kill children' line....

RelaxedAndCalm - sorry but I don't see ANYTHING in this thread which is remotely along the lines of 'all formula companies kill children' line....

I am sorry but the World Health Organisation spent a lot of time doing experiments, meeting commissioning reports and issued the guidance on how to make formula safely.

Fair enough if the formula companies DISAGREE with this information - but why don't they issue statements saying - Ah Yes we see what the WHO say but for XYZ reason we don't agree.

I don't think the formula companies have an interest in putting babies at risk but they are obviously money and profit driven.

This is the same as the pharma industry but I find the controls over the formula company to be lacking.

Yes people working there will be parents like you and me but ultimately the boards of the company make the decision - and their decision is to say they won't adopt the WHO guidelines (unless pressured to by individual companies) and they won't explain why they won't.

They could also give much more comprehensive info on how to make formula, different methods and levels of risk etc - but they don't.

Have you ever seen this which shows what they put on the side of the formula packs in other countries?

How would you go about reducing the number of hospital admissions due to D&V in FF babies. Possibly a lot of these are caused by infections introduced within the home and I think that lots of parents are very very casual about how they make formula.

I'm not talking now about the 70 degree thing but about lack of attention to hygiene, bottles hanging around all day.

I do not think there would be many on MN who do this sort of thing but amongst areas with poor education and social deprivation I think formula is held up as a magic potion - there is no awareness of the risks.

I think that formula companies should make DAMN sure that people know how to make the product up safely - but they don't - why - it would cost money and draw attention to the cons of formula.

Nutramigen and Enfamil instructions UK website.

Click on the blue and beige "book" and flick through the pages.

For most of the formulas including Nutramigen 1 and 2 it says to boil water and leave for 30 mins for Enfamil AR it says boil water and leave to cool to room temp.

They don't mention 70 degrees though (although that's where they get the 30 mins from).

Different volumes of water left in different kettles will take different amounts of time to get to 70 degrees - why don't they mention the 70 degrees?!?

The instructions don't state that feeding a baby a bottle at 70 degrees without cooling would be dangerous - but the don't include a specific cooling step - they just say right at the end to check the temp of the feed.

They give no alternative methods they don't even give the handy info about keeping water at 70 degrees in flasks.

Relaxedandcalm - are you satisfied that that company is doing enough to explain to you how to prepare feeds?

OK so I emailed the manufacturers of Nutramigen and Enfamil:

I see from your step by step guide to formula preparation that for most of your formulas you say to boil the kettle and leave the water for 30 mins but for Enfamil AR the advice is to leave the water to cool to room temperature.

Please can you answer a few questions:

1. What temperature should the water be after 30 minutes. Surely the temperature will depend on the volume of water in the kettle and the type of kettle?

ANSWER: As you mention below, WHO and DOH infant formula guidelines suggest that the temperature should be approximately 70 degrees after 30 minutes.

1. I suspect that you will answer 70 degrees to the above question, based on the WHO guidelines. If so then why don't you mention this on your website?

ANSWER: In an attempt not to over complicate the information for parents and to keep the instructions as clear and simple as possible.

1. What is your advice for situations where formula cannot be made freshly each time ?

ANSWER: As stated on the tin, ideally, "Feed immediately after preparation or cover and store in a refrigerator at 2-4 degrees Celsius for no longer than 24 hours"

1. Why can't Enfamil AR be made with the hotter water?

ANSWER Due to special formulation of Enfamil AR, lumps may form if the water is warm/hot.

1. Can you explain why your on pack information for Nutramigen states that the water should be boiled and cooled to room temperature? Have you recently changed the website?

ANSWER We have recently updated our labels - the new tins "Nutramigen LIPIL" state to cool the boiled water for 30 minutes prior to mixing.

___

So despite the guidelines being around for a few years - they have just decided to implement them now!

Is powdered formula the only powdered baby product that isn't sterile? I ask because baby rice is also a powder but the instructions say to make with cool water, as are some baby cereals and as someone mentioned earlier, Aptamil baby cereal has milk powder in it and says to make with cool water. I presume all of these are not sterile, so shouldn't they all be made with 70+ water? Or is it not seen as being important because babies are 6 months+ before they have these or is formula different somehow?

I've bumped this thread about sterilizing...

'Sorry - thread hijack I know but I get slightly infuriated when good conversations with useful info that helps people assess the risks in different ways of making up formula start going down the 'all formula companies kill children' line....'

Sorry Relaxed if that was aimed at me you took my meaning the wrong way - it seems that the manufacturers of Enfamil AR are just trying to protect themselves if any baby fed their product became ill as a direct result from using it - yes formula is a useful manufactured product so why don't the manufacturers tell mums and dads all the truth about their products so they have the full facts?

If this was any other sort of food which was labelled incorrectly or had directions that possibly lead to harm then there would be a big outcry?